Dr. Karen Horton has either authored or reviewed and approved this content.
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Many women seek breast reduction surgery when large, heavy breasts cause physical discomfort, limit activity, or affect self-image. Board-Certified Plastic Surgeon Dr. Karen Horton offers personalized breast reduction surgery (which always includes a major breast lift) for women in the San Francisco Bay Area who want to feel more comfortable in their bodies. With an emphasis on proportion, symmetry, and natural-looking results, Dr. Horton tailors each procedure to meet the unique goals and anatomy of the individual. For many patients, breast reduction is more than a cosmetic change—it’s a life-enhancing decision that can dramatically improve quality of life.
“I can’t thank you enough for the impact you have had on my life! Having a breast reduction was the best thing ever. I can run, bike, and dance without any pain. I am healing beautifully and can’t wait to get a bathing suit for the summer! Thank you, thank you, thank you!”
„A breast reduction, also known as “bilateral reduction mammaplasty”, is designed to relieve symptoms from excessive breast size and weight, known as symptomatic “macromastia”.2
Breast reduction surgery involves removing excess breast tissue, fat, and skin to achieve a smaller, more proportional breast size.1 As part of the procedure, the nipple and areola are repositioned higher on the breast, and the areola is often resized for improved balance. A breast lift is an essential component of breast reduction, helping to reshape and elevate the breasts so they appear more youthful and uplifted—not just smaller.
Dr. Horton performs an “auto-augmentation” technique for all her breast reductions that reshapes the breasts in addition to making them smaller and moves the breast tissue higher up on the chest wall. Liposuction is also added to reduce unwanted fat in the armpit region, known as the “axillary roll,” and the sides of the breast and upper back (the “bra roll”).
Drag the slider to see transformation
Drag the slider to see transformation
Drag the slider to see transformation
Breast reduction can be a life-changing procedure for many women, offering both physical relief and emotional empowerment. Whether part of a weight-loss journey or performed on its own, the benefits often extend well beyond aesthetics:
Good candidates for a breast reduction include women who are healthy, in good physical shape, and as close as possible to their ideal body weight (or a stable weight after major weight loss). You should not be obese (body mass index or BMI above 30), as an increased body mass index raises your risk of complications.
Women seeking reduction mammaplasty typically have one or more symptoms of macromastia:2
“I am in the process of training for my first Ironman. It has been a long 8 months of training, and it has been worth every minute. I am so incredibly grateful for the breast reduction you did for me in 2007. It has changed my life beyond belief, and seeing these pictures side by side, I am floored. Having you perform the surgery all those years ago gave me a new life that I am proud to live. Thank you from the bottom of my heart for the difference you have made in my life and for so many like me.”
„Breast reduction addresses several concerns: excess breast tissue and fat, stretched or enlarged areolas, sagging skin, and excess fat in the axillary (underarm) and lateral breast areas. The procedure combines volume reduction, breast reshaping, skin tightening, and repositioning of the nipple and areola to achieve a more lifted, balanced contour.
Key components include:
This three-dimensional procedure lifts and narrows the breast, often using incisions around the areola, vertically down the breast, and occasionally within the breast fold. Every effort is made to minimize visible scarring.
The superomedial pedicle method is our most commonly used approach. It involves a circular incision around the areola, a vertical incision to the inframammary fold, and often a short horizontal scar hidden in the fold. This technique preserves the blood supply, nerves, and ducts while maintaining fullness in the upper, inner breast for a naturally perky appearance. Breast tissue is removed from the lower and outer portions, and the areola is reduced and repositioned.
For patients with minimal excess skin and mild nipple droop, the lollipop technique may be an option. It uses only periareolar and vertical incisions—avoiding the horizontal fold scar—while still allowing for safe nipple repositioning. This approach is best suited for smaller reductions without significant sagging.
Both techniques aim to create a more youthful, proportionate breast shape while preserving function and sensation.
I am so glad I chose to have a breast reduction consultation with Dr. Horton. I had almost given up on finding a doctor - I actually did give up for a year before resuming my search for a doctor who I felt comfortable with enough to trust with my life and achieving a desirable result. That’s exactly who I found in Dr. Horton. During my consultation, she had such a personal and friendly demeanor that immediately put me at ease; she asked questions indicating she cared about my whole person where I almost forgot what the topic of my consultation was. But I could certainly feel the passion in her eyes for improving the lives of many. The dedication to her craft that surely propelled her into becoming a top ranked surgeon was not lost on me. The elusive feeling of confidence that I could not find in any other surgeons I consulted with had risen to the surface and I knew as I sat with Dr. Horton’s office, listening to her calm my fears as she describe the procedure and everything involved in great detail and viewing her awards of recognition and diplomas showcasing her professional achievements was very reassuring. To say the least, I am very pleased with my results. I am very pleased with my pre and post operative care. As such, I highly recommend Dr. Horton for anyone who is unsure or are fearful about undergoing surgery as a means to improve their lives. You do not have to continue putting off surgery out of fear. I know from experience that one of the most important and anxiety inducing areas of this process is finding a surgeon you trust will perform a job well done. You have found such a surgeon in Dr. Horton.
Dr. Horton is simply the best. I wouldn't trust anyone else to do my breast reduction. From my consultation appointment, pre-op, surgery, and post-op appointments, Dr. Horton has the most amazing bedside manner and willingness to answer every single question. Dr. Horton's staff also has the same willingness to assist with insurance questions & paperwork. I am so pleased with my results. My friends and family are astounded by Dr. Horton's precision: my breasts are symmetrical, perky, and perfectly placed. It's clear that Dr. Horton truly knows how to take a vision and make it a reality. I highly recommend Dr. Horton as an amazing plastic surgeon and confidant! Love, love, love her.
Preparing for breast reduction surgery involves maintaining a healthy lifestyle, arranging time off for recovery, and following all pre-op instructions from Dr. Horton.3 This may include lab work, medication adjustments, and avoiding certain supplements to ensure a smooth and safe procedure.
GLP-1 medications, such as semaglutide, should be discontinued at least one month prior to any procedure involving general anesthesia to help reduce surgical risks. For more information on how to manage diabetes or weight loss medications safely before surgery, read our full blog post.
Dr. Horton primarily performs the superomedial pedicle technique for breast reduction surgery. This outpatient procedure involves an incision around the nipple and areola, preserving blood supply from the upper inner quadrant of the breast. Excess breast tissue is removed from the lower and outer areas to relieve symptoms of macromastia while maintaining body proportion.
After tissue removal, the remaining breast tissue is reshaped using the auto-augmentation method to create a lifted, youthful contour. The pedicle, which carries the nipple’s blood supply and nerves, is repositioned without detachment, and the skin is redraped to match the new shape.
All removed breast tissue is sent to pathology for routine analysis. Drains are rarely needed, as the reshaped tissue naturally fills the space left behind—unlike in breast augmentation, where an implant is placed. Each surgery is fully customized, often guided by patient “wish pictures,” to achieve the most natural and satisfying results.
Please see our Preparing for Surgery section to learn about what happens in the operating room on the day of surgery.
Fat removed during a standard breast reduction from the axillary rolls and the back fat/bra roll. This accentuates the cosmetic outcome and rids women permanently of the annoying armpit fat that peeks out from your tank tops!Breast reduction recovery is typically straightforward, with most patients returning to normal activities within a few weeks. Post-op discomfort, swelling, and temporary asymmetry are common but can be managed with prescribed pain medication and supportive garments. By reducing the size of your breasts and removing excess fat and tissue, the procedure can relieve symptoms like back and neck pain while improving body proportions. As with all surgical procedures, individual results vary, but many patients report a renewed sense of confidence and comfort in their appearance. Patient testimonials frequently highlight improved posture, easier movement, and a better fit in clothing. Dr. Horton also provides guidance on long-term scar and skincare to support optimal healing and results.
Breastfeeding was indeed possible after my breast reduction! At 18 years old, I didn’t consider the effects the surgery could have on breastfeeding too strongly, I hadn’t even considered children yet, and while I was appropriately counseled; it didn’t weigh heavily on my decision. With the assistance of routine skilled care by midwives and a lactation consultant, I WAS able to breastfeed my daughter, THEN my twin girls easily and exclusively! I am glad that this was still an option for me, as it has proved to be a very rewarding experience. Thank you, Dr. Horton, for your excellent care. I am so happy with my decision to have a breast reduction with Dr. Horton.
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Please note that pricing will vary and all information provided represents an average of typical costs and time and does not guarantee pricing or availability. Your individual treatment plan will be personalized to meet your needs and we recommend scheduling a consultation to receive a more accurate breakdown of pricing and recovery expectations.
Ready to reduce discomfort and achieve a lighter, more balanced silhouette? Contact us to book your personalized breast reduction consultation with Dr. Karen Horton in San Francisco today.
What Are the Potential Risks and Complications of Breast Reduction?
Please see our Preparing for Surgery section to learn about risks and potential complications related to surgery, and Postoperative Instructions for Breast Surgery for additional information pertaining to breast reduction.
Will a Breast Reduction Interfere with Breast Function?
One of the goals of breast surgery is to preserve both nipple sensation and the ability to breastfeed. During a breast reduction, excess breast tissue is typically removed from the lower and outer areas, while key structures—such as milk ducts, nerves, and blood vessels—are preserved whenever possible.The remaining tissue is reshaped to create a smaller, lifted breast. In an auto-augmentation, the nipple, areola, and upper breast tissue are repositioned to enhance upper pole fullness—similar to the effect of a breast implant—while liposuction may be used to reduce excess fat from the armpits and sides.While breast reduction can impact the ability to breast feed, preserving milk ducts increases the chance of successful breastfeeding. Some women may still need to supplement with formula, regardless of surgery. Nipple sensation usually returns gradually, though full recovery can take several months to over a year.
Is Liposuction Part of a Breast Reduction?
Dr. Horton always includes liposuction in breast reduction surgery to contour the outer breast, axillary (armpit) area, and “bra roll” region. While it helps remove excess fat and enhance the final shape, liposuction alone cannot reshape the breast, lift the nipples, or address excess skin. Instead, it’s used alongside breast tissue removal to improve aesthetic results, minimize scarring, and eliminate stubborn areas of fat for a more refined and balanced outcome.
Is a Breast Reduction Part of a Mommy Makeover?
Breast reduction is often included as part of a Mommy Makeover procedure. To learn more about how pregnancy can affect the breasts, abdomen, and other areas—and how breast reduction can help restore comfort and proportion—visit our Mommy Makeover page.
Where Can I See Before and After Photos of Breast Reduction Procedures?
Visit our photo gallery to see before and after breast reduction results!
Is Breast Reduction Surgery Covered by Insurance?
A breast reduction is often considered cosmetic, particularly if it is being done solely to improve the appearance of the breasts. However, if signs or symptoms of macromastia are present, it may be covered in part or completely by insurance. Dr. Horton is no longer a participating provider for any insurance plans. However, our office may be able to assist with out-of-network billing. Mary Pasache can answer additional questions about this.
How Do I Best Plan for My Breast Reduction?
To prepare for breast reduction or any breast surgery, we recommend gathering “wish pictures” to help communicate your goals. These should include both YES images (examples of breasts that reflect your ideal shape, size, and proportions) and NO images (looks you’d like to avoid). Focus on body type and aesthetics rather than cup size—proportion, projection, and overall balance matter most. Our before and after gallery is a great place to start, and additional images from online searches can be helpful too. These visuals guide your consultation and help set clear, realistic expectations.
Is There Anything Else I Should Know About Breast Reduction Surgery?
Breast reduction offers immediate relief for most women, and many say, “Why did I wait so long?” Still, it’s normal to experience an emotional adjustment as your body image shifts. After years—sometimes decades—of considering surgery, waking up with a new breast size can feel surreal, even when the outcome is positive. These feelings are temporary. Breast reduction consistently ranks as one of the most satisfying procedures in Plastic Surgery,4 and most patients quickly embrace their results as they heal and adjust to their new shape.
Will I Need Additional Surgery after a Breast Reduction?
Breast reduction results are long-lasting, with most patients enjoying a smaller, lifted shape for many years. While your breasts will naturally age over time, no further surgery is needed unless you experience issues or choose to make changes later. Follow-up care helps ensure your results continue to look and feel great.
Is There a Minimum or Maximum Age for Breast Reduction?
There is no minimum or maximum age for breast reduction. This procedure is designed to improve quality of life, and it can be appropriate for both younger and older breast reduction patients. For teens, surgery may be considered once breast development is mostly complete, especially if large breasts are interfering with physical activity or self-esteem. In some cases, additional growth may occur after surgery, which could require future revision.
Older women can also benefit greatly from breast reduction, gaining relief from chronic discomfort and increased freedom of movement. As long as a patient is healthy enough to undergo general anesthesia, age alone is not a limiting factor. Your overall health and personal goals will guide the decision-making process during your consultation.
How Do I Know Whether a Breast Reduction is Right For Me?
At your initial breast reduction consultation, Dr. Horton will spend a great deal of time getting to know you personally and taking a complete medical history. As women Plastic Surgeons, we intimately understand how a woman’s feelings about her breasts can influence her self-image and her femininity, and we aim to help you feel better, move better, and give you the result you are looking for! We will explore your reasons for seeking breast reduction, examine your breasts, and if you are an appropriate candidate for surgery, your options will be described in detail.
Can I combine any other procedures with breast reduction?
Yes, breast reduction is often combined with other cosmetic surgery procedures for a more comprehensive transformation. Many breast reduction patients choose to pair their procedure with body contouring treatments such as a tummy tuck or liposuction to enhance their overall silhouette. In some cases, breast augmentation with implants or fat transfer may also be performed to restore volume in the upper portion of the breast after reduction. Dr. Horton will work closely with you to create a surgical plan that aligns with your goals and delivers natural, balanced results.
Where can I find breast reduction near me?
If you’re looking for breast reduction surgery in San Francisco, Dr. Karen Horton is a Board-Certified Plastic Surgeon serving patients throughout the Bay Area. With extensive experience in breast procedures and a personalized approach to care, Dr. Horton offers breast reduction tailored to each individual’s needs and anatomy. To learn more or schedule a consultation, contact our San Francisco office today.
1 American Society of Plastic Surgeons. Breast Reduction. https://www.plasticsurgery.org/reconstructive-procedures/breast-reduction. Accessed May 6, 2025.
2 Mayo Clinic. Breast reduction surgery. https://www.mayoclinic.org/tests-procedures/breast-reduction-surgery/about/pac-20385246. Accessed May 6, 2025.
3 Cleveland Clinic. Breast Reduction. https://my.clevelandclinic.org/health/treatments/11025-breast-reduction. Accessed May 6, 2025.
4 Johns Hopkins Medicine. Breast Reduction Surgery. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/breast-reduction-surgery. Accessed May 6, 2025.
Dr. Karen Horton has either authored or reviewed and approved this content.
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Dr. Karen M. Horton
2100 Webster St UNIT 520
San Francisco, CA 94115
Phone: 415.923.3067
We are located in the Pacific Heights District in the Pacific Professional Building.
Monday-Friday: 9am - 5pm
Saturday-Sunday: Closed
Monday:
9 AM to 5 PM
Tuesday:
9 AM to 5 PM
Wednesday:
9 AM to 5 PM
Thursday:
9 AM to 5 PM
Friday:
9 AM to 5 PM
Saturday:
Closed
Sunday:
Closed
Dr. Karen M. Horton
2100 Webster St UNIT 520
San Francisco, CA 94115
Phone: 415.923.3067
We are located in the
Pacific Heights District
in the Pacific Professional Building.
SHOP SKIN CARE*Please note: Our office is no longer a Participating Provider for insurance. We can provide a financial quote for what anticipated surgical fees will be after your consultation.
